In general, some of us age better than others. And sometimes there are unnecessary changes and consequences that, up until now, have been ill addressed.
As a gynecologist and obstetrician, I have delivered thousands of babies including 4 of my own. Through this experience, I became acutely aware of the metamorphic changes that occur to our whole body, especially our breasts and vagina.
If you too have experienced pregnancy, have breastfed, delivered vaginally, or had a perineal tear or episiotomy, you know you become acutely aware of some of the pains and strains. You also become aware of the amazing and beautiful capability of our feminine body parts.
How amazing that 9 lb baby came out of there! Wow! And that it recovers from all that stretching pretty quickly!
Yes, Our Pregnancy Hormones Enable These Changes.
Other things I witnessed was how some would tear more easily than others during childbirth, or have incontinence and vaginal dryness afterward. Some evolved to sexual dysfunction. I witnessed and cared for those with incontinence and prolapse or pelvic relaxation syndromes, vaginal atrophy, even vaginal stenosis throughout the decades of my medical practice.
As time passed I saw these changes through the generations.
My studies, interest, and expertise developed in functional medicine, sexual health and hormones and I began to notice some things…Women also came to me to be treated surgically for incontinence doing anterior and posterior repairs, para vaginal repairs, bladder lifts, and slings.
I was trained by the best of the best at Emory University and our techniques were really restorative… to a degree.
I soon recognized that we have to treat the underlying causes before addressing with a non-emergency surgical procedure.
I recognized that estrogen, what is most commonly prescribed for vaginal dryness, did rarely improve incontinence, nor have any real significant improvements in orgasm or sexual function, although it’s very safe when inserted vaginally.
Based on my research, I recognized that estrogen-only effects the mucosal layer of the vagina and does not do very much at all, if anything to improve the muscular layers.
When I started using androgen therapy such as bio-identical DHEA and testosterone vaginally or applied topically to the vulvar area, I was getting great results for sexual health and vaginal dryness and my clients loved it! They also started reporting decreased incontinence symptoms.
Let Me Illustrate The Evolving Scenario With An Example
Sue came to me complaining of incontinence when she coughed, sneezed, jumped or tried to exercise. Also, she was very shy to say, she was starting to have some leaking during intercourse with her husband.
After examination, ultrasound and bladder studies, I diagnosed simple stress incontinence. I can fix this with a sling easily – outpatient surgery and it will take 30 minutes. I’d done hundreds of incontinence surgeries. Well, up until that point, I’d always prescribed vaginal estrogen in the past for 2-4 weeks pre-operatively to improve the tissue and surgical outcome; but this time, based on my research, I tried something new. I prescribed vaginal testosterone and DHEA and scheduled her for her pre-op for surgery in 2 weeks.
When she came back she was asymptomatic (she had none of her earlier symptoms)! What?!
“You don’t have anymore symptoms?” I asked
“None! And my sex life is better than ever. My husband thanks you too!”
“Well, I can’t exactly operate now, can I?” I said, really impressed.
“You mean, I don’t need surgery?” she asked, equally bewildered.
“Exactly.” I responded. “No symptoms, no surgery.”
The Results Confirmed My Research!
I had known, based on my research, that I’d get an improvement in the vaginal muscles but really didn’t expect such a significant and quick response! My exam verified, that in just a couple weeks, there was an improvement in her vaginal ruggations (the normal folds and elasticity) as well as contractility (the ability to contract the muscles of the pelvic floor). This meant more strength, more support to the urethra and bladder too.
Interestingly, I was in my eighth month of pregnancy with my son. It was 2004, and I’d had a surgical day in which I did 6 bladder slings in a day. I made sure to follow up each of those clients with some vaginal androgen therapy too because of the newly evolving risks of mesh erosions and complications. I attribute my never having any issues or complications to this fact as well as the functional approach I followed my patients with.
Not true for many women however who have suffered devastating complications from vaginal and bladder surgeries. I’ve treated those, too, with vaginal hormones, probiotics, and believe it or not, my detox which is a gut restoration program.
Well, once my son was born, I stopped OB (intending to go back once he stopped breastfeeding) and my practiced evolved more into gynecology and menopausal health.
I found that by using vaginal androgen therapy I rarely needed to operate. In fact, I never did another sling procedure.
(This is not what hospitals want to hear by the way!)
Fascinating isn’t it!
(While not everyone will be able to avoid surgery for incontinence, prolapse or other situation…the vulvar cream that I developed, Julva®, is designed to improve the skin in this area which should improve outcome…more on Julva below).
My love for medicine and healing and excitement that these very safe and effective methods could restore healthy vaginal function drove me to lecture about it and to find even more practical solutions to help more women…thereby helping the couple, the relationship, and the family…
Women from far and wide wanted me to help them, but if they were not my patient, and if I wasn’t able to evaluate them in my office, I could not prescribe vaginal hormones for them.
Then it occurred to me that DHEA is over the counter and I could make a vaginal tablet, like a sublingual tiny lozenge, that dissolves under the tongue, for the vagina. And it needed to be odorless, tasteless, be small and effective.
One of the downsides of vaginal hormones is that they are made as suppositories or creams and depending on the compounding pharmacy, they might vary. Worse than that, is that in Southeast Georgia, they will melt! In the summer you have to keep them in the fridge.
And I Did Create It
Within a few months, women were ordering from all over the country. But then my manufacturer realized that once we insert something into the vagina, it becomes a drug and we had to STOP offering it. We could no longer produce it without going through all of the expense and requirements of getting it qualified as a prescription drug.
Plus, I really wanted a non-prescription solution. I knew from experience that many women won’t go to their doctor and ask for such a prescription.
We Were All Devastated
Physicians could still order the product I designed and make it available to their patients by prescription. Or physicians could have their compounding pharmacy make something similar. But many wouldn’t do so. Why?
At that time, my PTSD from my young son’s accident was flaring, and I retired my clinical practice. Women would write an email for the product I created. My office would have to tell them that they would need their physician to prescribe it.
But this is not something many physicians would do. I would say even less than 1% are comfortable with or know how to do. It is really specialized. I know this because I lecture on Sexual Health all over the country and when I’ve asked the question: “How many here prescribe vaginal hormones other than estrogen?” less than a fraction of a percentage of the room will raise their hands and often none, even in a room of OB/GYN's and Urologists.
It’s part of my passion to continue to teach this.
I Needed To Develop The Perfect OTC Topical That Could Help Women as Much as The Vaginal Tablet
Once we found out the vaginal solution had to be by prescription I began trying to develop a topical that would be as wonderfully effective and even more so.
I wanted this topical solution to be:
- Healing of vaginal dryness
- Increase lubrication and healthy glandular function
- Improve sexual function and satisfaction and pleasure
- Improve the symptoms of incontinence
- And yes… be tasteless and smell good!
I’ve perfected this cream with love and prayers that it helps women around the world feel good about our feminine bits, especially as we deal with the normal changes of age. I’ve focused on making it really safe, and along with addressing all of the above…it is designed to effectively improve the divinely designed function of our beautiful, feminine, pelvic floor.
There is a lot of great research supporting the effectiveness of the natural hormone, DHEA, that I’ve used in my formulation. Many other wonderful, nourishing ingredients as well, including Alpine Rose Stem Cells. Here is just some of the research listed below if you are interested in learning more…or ask me a question (or check out Julva Frequently Asked Questions)! I’d love to hear from you. Email me at firstname.lastname@example.org.
References on DHEA as effective treatment for vulvar and vaginal atrophy and related symptoms:
F Labrie, MD, PhD, ‘Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause’, The Journal of The North American Menopause Society Vol. 23, No. 3, 2016, pp. 243-256
F Labrie, MD, PhD, ‘Intravaginal dehydroepiandrosterone (Prasterone), a physiological and highly efficient treatment of vaginal atrophy’ , The Journal of North American Menopause Society, Vol. 16, No. 5, 2009, pp. 907/922
F Labrie, MD, PhD, ‘Effect of intravaginal dehydroepiandrosterone (Prasterone) on libido and sexual dysfunction in postmenopausal women’, The Journal of the North American Menopause Society, Vol.16, No. 5, 2009, pp.923/931
F Labrie, P Diamond, L Cusan, JL Gomez, A Be’langer, B Candas. “Effect of 12-month dehydroepiandrosterone replacement therapy on bone, vagina, and endometrium in postmenopausal women.’, J Clin Endocrinol Metab 1997;82:3498-3505.
F Labrie, DF Archer, W Koltun, A Vachon, D Young, L Frenette, D Portman, M Montesino, I Cote, et all. “Efficacy of intravaginal dehydroepiandrosterone (DHEA) on moderate to severe dyspareunia and vaginal dryness, symptoms of vulvovaginal atrophy, and of the genitourinary syndrome of menopause’, Menopause, 2016 Mar: 23(3):243-56
F Labrie. “Treatment of pain at sexual activity (dyspareunia) with intravaginal dehydroepiandrosterone (Prasterone)’, The Journal of The North American Menopause Society. Vol 22, No.9. 2015. pp 950-963